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08/10/2004 13:07 FAX 14024714429 V' Or nabraska department olrevenue NEBRASKA UCC 20040'7932 IM 004/004 Notice of State Tax Lien PLEASE DO NOT WRITE IN THIS SPACE INDIVIDUAL .INCONE TA sac* SEC4 Mae 530OZ9452 NEBR. IDENT. NOO 41996TTI SPOUSE SOC. SEC &' NGa 5OT21537 9 TAXABLE YEAR 2001 LIEN . N0w 030450363 COUNTY HALL DONALU'NE JESSICA KAY'MCCORRICK III DATE OF NOTICE 02/14/2003 107 S OAK ST APT 3: DATE OF ASSESSMENT 11/15/2002 GRAND ISLAND ME 58801 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIYIDUAL INCUME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE Of NEBfRASKA. NOTICE IS HEREBY GIVEW . THAT INDIVIDUAL :INCDME TAXES INCLUDING PENALTIES AND INTERES TY WHICH ARE SHOJM ` SELOW' ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER'DEMAANfl• Ti:`ESE TAXES CONSTITUTE A `LIEN" IW THE CMMTY FOR PROPERTY BELONGING TO THE TAXPAYER.OR HEREAFTER ACQUIREDm AMOUNT OF TAX ''@ a • . . . . . 0:0 . . a . a a . , 525.71 PENALTY . . ' a • - • a . . . . a . . . . a a . a . . 62015? INTEREST (COMPUTED TO 02/14/2013) . . . . 44. 44 TOTAL AMDUNT DUE . • , . . • . . . . � :. 733.gZ 3 HEREBY CERTIFY THAT THE WMcERASKA ;E;ART;EN*T DF ROE1Ef�NUE HAS COMPLIED WITH THE REVENUE LAWS OF THE STATE OF NEBRASKA IN THE D.ETERNINATIDN . UF THE AMOUNT. SHOWN To BE .DUE, AND THE TAXPAYER HAS FAILED TO PAY Tw AMOUNT .DUE AFTER DEMAND- IF THIS NOTICE OF STATE TAX LIEN IS AN EXTENSION OF AN EFFECTIVE LIEN IT SERIES TO CONTINus- THE PRIORITY OF THE STATE'S INTEREST Its THE AFFECTED PROPERTY OF THE TAXPAYER. PREP ER *S S E TITi EE DATE/TELEPHONE A THORIIE SIGNATURE TITLE HATE NEBRASKA DEPARTMENT OF REVENUE — White and Canary Copies TAXPAYER — Pink Copy Pmed with soy ink on rwyWed paper 7- 145.1979 Rev- 2 -2000 supersedes 7- 145.1979 Rev. 10 -1995